A systematic review on the effects of non-pharmacological interventions for fatigue among people with upper and/or lower limb osteoarthritis

Objectives To identify non-pharmacological fatigue interventions and determine the effectiveness of these non-pharmacological interventions in reducing fatigue immediately and over time in OA.Methods A review protocol (CRD42020163730) was developed and registered with the PROSPERO database. Included studies comprised peer-reviewed randomized controlled trials (RCTs) that examined the effects of conservative interventions on fatigue in people with upper and lower limb OA. Cochrane Collaboration's tool for assessing the risk of bias (ROB-2) was used to assess the quality of evidence of studies. Narrative synthesis was used to summarize the effectiveness of identified fatigue interventions.Results Out of 2644 citations identified from databases, 32 reports were included after screening for titles, abstracts and full texts. Of these reports, 30 parallel RCTs, one cluster and one cross-over RCT were included. 13 RCTs were of low ROB, 6 had some concerns and 13 had high ROB. The narrative synthesis identified interventions for fatigue including exercise, activity pacing, cognitive behavioural therapy, telerehabilitation and complementary alternative therapies. Exercise interventions showed the most significant beneficial effects on fatigue.Conclusions Diverse interventions for fatigue management among individuals with upper and lower limb OA were identified. Of these, exercise interventions appear to be the most promising with the majority of these interventions favouring fatigue improvement. While cognitive behavioural therapy has limited evidence of beneficial effects, there is insufficient evidence regarding the effectiveness of other identified interventions, including complementary and alternative therapies, and telerehabilitation. What does this mean for patients?Fatigue, a feeling of tiredness or exhaustion, is a common symptom reported by people with OA which may lead to impairment of physical function and quality of life. There is a need to identify non-drug treatments that can be used to reduce fatigue immediately and over time among individuals with OA. This review found twelve treatments for fatigue for osteoarthritis. These include activity pacing, cognitive behavioural therapy, yoga, exercise, acupuncture, moxibustion, pain-coping skills, BEMER therapy, modified shoes, massage/aromatherapy, education and thermotherapy. Of these, exercise interventions appear to be the most promising treatment for fatigue improvement. Other treatments that may require further studies include cognitive behaviour therapy, complementary and alternative therapies, and telerehabilitation.